DISCONTINUATION OF ANTIPSYCHOTICS IN NURSING-HOME PATIENTS WITH DEMENTIA

The authors assessed the consequences of stopping antipsychotic medica tion in nursing home patients with dementia, as mandated by federal re gulations (OBRA 87). They studied three patient groups: 1) a group ('' clinical judgment'') whose antipsychotics were discontinued at the dis cretion of their physicians; 2) a group (''empirical'') with mandated cessation of antipsychotics in the facility; and 3) a comparison group of patients not receiving medication. The primary outcome measure was the necessity to resume antipsychotic or other psychotropic medicatio n (''failure''). Also, assessments of behavior, function, neurologic s tatus, and cognition were performed by blind raters. The failure rate in the empirical withdrawal group was 50%, 10 times that of the clinic al judgment group. Among failures, the most striking result was increa sed verbal and physical aggression. No failures occurred in the compar ison group. There were no benefits of antipsychotic withdrawal in term s of neurological performance, functional status, or cognition.